At a glance: Medicare health insurance in Florida
- More than 4.4 million Florida residents are enrolled in Medicare.
- 42 percent of Florida Medicare beneficiaries select Medicare Advantage plans.
- Residents in Florida can select from between eight and 68 Medicare Advantage plans in 2019, depending on where they live.
- Florida has a tool residents can use to compare prices on Medigap plans in each county.
- Florida law guarantees access to Medigap plans for enrollees under age 65, but premiums are higher for these enrollees.
- Only about a third of Florida’s Medicare beneficiaries have stand-alone Part D prescription coverage.
- Per-enrollee Medicare spending in Florida is just slightly lower than the national average.
Medicare enrollment in Florida
4,415,447 Florida residents were enrolled in Medicare as of November 2018. That’s more than 20 percent of the state’s total population, compared with a little more than 18 percent of the United States population enrolled in Medicare.
87 percent of Medicare beneficiaries in Florida are eligible due to age (ie, being at least 65), while the other 13 percent are eligible due to a disability. Nationwide, 84 percent of Medicare beneficiaries are eligible due to age, while 16 percent are eligible due to disability. But Florida has the highest percentage of 65+ residents in the country, so it makes sense that a greater percentage of the state’s Medicare beneficiaries are eligible due to age.
Medicare Advantage in Florida
42 percent of Florida Medicare beneficiaries selected private Medicare Advantage plans in 2017. Nationwide, the average was 33 percent, so Medicare Advantage is more popular in Florida than it is nationwide. Most of the remaining 58 percent of the state’s Medicare beneficiaries had opted instead for coverage under Original Medicare, but there are also some Florida Medicare beneficiaries with Medicare cost plan coverage.
Residents in some counties in Florida can choose from as many as 68 different Medicare Advantage plans in 2019, although some counties only have eight or nine different options. As of 2019, there’s a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.
Medigap in Florida
Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.
The Florida Office of Insurance Regulation (FLOIR) has a very user-friendly website people can use to compare premiums for Medigap plans available in each county in the state. FLOIR reported that as of 2016, there were 853,123 Florida residents with Medigap coverage.
Medigap plans are standardized under federal rules, and people are granted a six-month window, when they turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.
But Florida is among the majority of the states have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65. Since 2009, Florida residents under age 65 are granted a six-month window (starting when they’re enrolled in Medicare Part B) during which coverage under a Medigap plan is guaranteed-issue. The premiums are typically higher for enrollees under age 65, although they are given another enrollment window when they turn 65, so they can then switch to lower-cost Medigap coverage at that point.
Medicare Part D in Florida
Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan.
As of November 2018, there were about 1.5 million Florida Medicare beneficiaries who were enrolled in stand-alone Part D prescription drug plans. That’s about 33 percent of the state’s total Medicare beneficiaries, as opposed to about 43 percent of all Medicare beneficiaries nationwide enrolled in stand-alone Part D plans. But in Florida, where Medicare Advantage enrollment is higher than the national average, nearly 1.9 million Medicare beneficiaries get their Part D coverage under a Medicare Advantage plan, which accounts for about 42 percent of the state’s Medicare beneficiaries.
For 2019 coverage, there are 27 stand-alone Part D plans available in Florida, with premiums ranging from $13 to $156 per month.
Medicare spending in Florida
In 2016, Original Medicare spent an average of $11,041 per beneficiary in Florida (the data was standardized to eliminate differences in payment rates from one area to another, but it was only based on Original Medicare spending, so it did not include costs for Medicare Advantage enrollees). The national average that year was $9,533 per enrollee, so Medicare spending in Florida was 16 percent higher than the national average. Florida was one of just three states (the others are Louisiana and Texas) where Medicare’s average per-enrollee costs exceeded $11,000 in 2016.
You can read more about Medicare in Florida in our state Medicare guide. You can also contact SHINE, Florida’s health insurance assistance program for seniors, with questions related to Medicare coverage in Florida.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.